结直肠癌卵巢转移14例临床病理分析

Colorectal cancer with ovarian metastasis:a clinicopathologic study of 14 cases

目的探讨结肠/直肠癌(CRC)卵巢转移性肿瘤的临床病理学特征。方法收集CRC卵巢转移14例,对其临床特点、病理学及免疫表达进行分析。结果患者年龄47~79岁,中位年龄59岁。9例见网膜/腹膜结节或腹水,8例单侧卵巢转移,3例双侧病变不对称性增大,肿瘤直径2.5~23.0 cm,平均12.7 cm。镜下多数病例以膨胀性浸润为主,可见类似卵巢原发黏液性肿瘤形态改变,少数呈黏液腺癌或印戒细胞形态,易见上皮间质裂隙。免疫表型:肿瘤细胞CK20、SATB2、CDX2阳性,CK7阴性或弱阳性。3例术中快速误诊为卵巢原发性肿瘤。结论CRC卵巢转移单侧多见,双侧卵巢转移中,病变可呈不对称增大,诊断需结合病史、术中情况、组织学特征并辅以免疫组化综合分析。需主要与卵巢原发性黏液性肿瘤鉴别。

Objective To explore the clinicopathological characteristics of ovarian metastatic tumors of colorectal cancer(CRC).Methods Fourteen cases of CRC ovarian metastasis were collected,and their clinical features,pathology and immunohistochemistry were analyzed.Results The patients were aged 47-79 years,with a median age of 59 years.Nine cases had omental/peritoneal nodules or ascites,eight cases had unilateral ovarian metastasis,and three cases had bilateral lesions with asymmetric enlargement,with tumor diameters ranging from 2.5 to 23.0 cm.Microscopically,most cases showed expansive infiltration,with morphological changes similar to primary ovarian mucinous tumors.A few cases showed mucinous adenocarcinoma or signet ring cell morphology,and epithelial-mesenchymal clefts were easily seen.Immunophenotypeically,tumor cells were positive for CK20,SATB2,CDX2,and negative or weakly positive for CK7.Three cases were misdiagnosed as primary ovarian tumors by intraoperative frozen section.Conclusion CRC ovarian metastasis is more common in unilateral ovaries,and in bilateral ovarian metastasis,the bilateral lesions may show asymmetric enlargement.The diagnosis should be based on the history,intraoperative findings,histological features and immunohistochemistry.The diagnosis of CRC ovarian metastatic tumors needs to focus on the differentiation from primary ovarian mucinous tumors.